Methamphetamine is a powerfully addictive
stimulant that dramatically affects the central
nervous system. The drug is made easily in
clandestine laboratories with relatively inexpensive
over-the-counter ingredients. These factors combine
to make methamphetamine a drug with high potential
for widespread abuse.

Methamphetamine is commonly known as
"speed," "meth," and
"chalk." In its smoked form, it is often
referred to as "ice," "crystal,"
"crank," and "glass." It is a
white, odorless, bitter-tasting crystalline powder
that easily dissolves in water or alcohol. The drug
was developed early in this century from its parent
drug, amphetamine, and was used originally in nasal
decongestants and bronchial inhalers.
Methamphetamine's chemical structure is similar to
that of amphetamine, but it has more pronounced
effects on the central nervous system. Like
amphetamine, it causes increased activity, decreased
appetite, and a general sense of well-being. The
effects of methamphetamine can last 6 to 8 hours.
After the initial "rush," there is
typically a state of high agitation that in some
individuals can lead to violent behavior.

Methamphetamine comes in many forms and can be
smoked, snorted, orally ingested, or injected. The
drug alters moods in different ways, depending on
how it is taken.

Immediately after smoking the drug or injecting
it intravenously, the user experiences an intense
rush or "flash" that lasts only a few
minutes and is described as extremely pleasurable.
Snorting or oral ingestion produces euphoria - a
high but not an intense rush. Snorting produces
effects within 3 to 5 minutes, and oral ingestion
produces effects within 15 to 20 minutes.

As with similar stimulants, methamphetamine most
often is used in a "binge and crash"
pattern. Because tolerance for methamphetamine
occurs within minutes - meaning that the pleasurable
effects disappear even before the drug concentration
in the blood falls significantly - users try to
maintain the high by binging on the drug.

In the 1980's, "ice," a smokable form
of methamphetamine, came into use. Ice is a large,
usually clear crystal of high purity that is smoked
in a glass pipe like crack cocaine. The smoke is
odorless, leaves a residue that can be resmoked, and
produces effects that may continue for 12 hours or
more.

As a powerful stimulant, methamphetamine, even in
small doses, can increase wakefulness and physical
activity and decrease appetite. A brief, intense
sensation, or rush, is reported by those who smoke
or inject methamphetamine. Oral ingestion or
snorting produces a long-lasting high instead of a
rush, which reportedly can continue for as long as
half a day. Both the rush and the high are believed
to result from the release of very high levels of
the neurotransmitter dopamine into areas of the
brain that regulate feelings of pleasure.

Methamphetamine has toxic effects. High doses can
elevate body temperature to dangerous, sometimes
lethal, levels, as well as cause convulsions.

Long-term methamphetamine abuse results in many
damaging effects, including addiction. In addition
to being addicted to methamphetamine, chronic
methamphetamine abusers exhibit symptoms that can
include violent behavior, anxiety, confusion, and
insomnia. They also can display a number of
psychotic features, including paranoia, auditory
hallucinations, mood disturbances, and delusions
(for example, the sensation of insects creeping on
the skin, which is called "formication").
The paranoia can result in homicidal as well as
suicidal thoughts.

With chronic use, tolerance for methamphetamine
can develop. In an effort to intensify the desired
effects, users may take higher doses of the drug,
take it more frequently, or change their method of
drug intake. In some cases, abusers forego food and
sleep while indulging in a form of binging known as
a "run," injecting as much as a gram of
the drug every 2 to 3 hours over several days until
the user runs out of the drug or is too disorganized
to continue. Chronic abuse can lead to psychotic
behavior, characterized by intense paranoia, visual
and auditory hallucinations, and out-of-control
rages that can be coupled with extremely violent
behavior.

Although there are no physical manifestations of
a withdrawal syndrome when methamphetamine use is
stopped, there are several symptoms that occur when
a chronic user stops taking the drug. These include
depression, anxiety, fatigue, paranoia, aggression,
and an intense craving for the drug.

Methamphetamine abuse has three patterns, low
intensity, binge and high intensity. Low intersity
abuse describes a user whi is not psychologiacally
addicted to the drug but uses it on a casual basis
by swallowing or snorting it. Binge and high
intensity abusers are psychologically addicted and
prefer to smoke or inject it to achieve a faster and
stronger high. Binge users use it more that low
intensity abusers but less that high intensity
abusers.

Tweaking occurs at the end of the binge when
nothing the abuser does will take away the feeling
of emptiness and dysphoria, including taking more
methamphetamine. Tweaking is very uncomfortable, and
the abuser often takes a depressant to ease the bad
feelings. The most popular depressant is alcohol,
with heroin a close second. Tweaking is the most
dangerous stage of the methamphetamine abuse cycle
to law enforcement officers and other individuals
near the abuser. If the abuser is using alcohol to
ease the discomfort, the threat to law enforcement
officers intensifies. During this stage, law
enforcement officers must clearly identify the
underlying dangers of the situation and avoid the
assumption that the tweaker is just a cocky drunk.

To a binge abuser, the crash means an incredible
amount of sleep. The body's epinephrine has been
depleted, and the body uses the crash to replenish
its supply. Even the meanest, most violent abuser
becomes almost lifeless during the crash and poses a
threat to no one. The crash can last 1-3 days

Often 30-90 days must pass after the last drug
use before the abuser realizes that he is in
withdrawal. First, without really noticing, the
individual becomes depressed and loses the ability
to experience pleasure. The individual becomes
lethargic; he has no energy. Then the craving for
more methamphetamine hits, and the abuser often
becomes suicidal. If the abuser, however, takes more
methamphetamine at any point during the withdrawal,
the unpleasant feelings will end.

The high-intensity abusers are the addicts, often
called speed freaks. Their whole existence focuses
on preventing the crash, and they seek that elusive,
perfect rush--the rush they had when they first
started smoking or injecting methamphetamine. With
high-intensity abuser, each successive rush becomes
less euphoric, and it takes more methamphetamine to
achieve it. Each high is not quite as high as the
one before. During each subsequent binge, the abuser
needs more methamphetamine, more often, to get a
high that is not as good as the high he wants or
remembers. Tweaking for the high-intensity abuser is
still the most dangerous time to confront him
because tweakers are extremely unpredictable and
short-tempered. The crash is often spoken of in
terms of "I never sleep," or "I sleep
with one eye open." In an attempt to appear
normal, perhaps because of an appointment with a
doctor, lawyer, or court official, high-intensity
abusers will make themselves take short naps;
otherwise, they see no need to come down from the
high.

A methamphetamine abuser is most dangerous when
tweaking. The fact that a law enforcement officer is
confronting the tweaker makes him more dangerous,
not just to the officer on the scene but also to
anyone nearby. When tweaking, the abuser has
probably not slept in 3-15 days and consequently
will be extremely irritable. The tweaker craves more
methamphetamine, but no dosage will help re-create
the euphoric high. The result is a strong feeling of
uncontrollable frustration that makes the tweaker
unpredictable and dangerous. If the law enforcement
officer on the scene is unfamiliar with the physical
signs of a tweaker, the abuser can appear normal. In
fact, unlike a person intoxicated on alcohol with
glassy eyes, slurred speech, and difficulty even
standing up, a tweaker appears super-exaggerated
normal. The tweaker's eyes are clear, his speech
concise, and his movements brisk. With a closer look
at the tweaker, law enforcement officers will notice
that his eyes are moving about ten times faster than
normal and may roll. He is talking in a quick, often
steady voice with a slight quiver to it, and his
movements are quick and jerky. The individual's
movements are often exaggerated because he is
overstimulated, and his thinking is scattered and
subject to paranoid delusions. The tweaker does not
need provocation to react violently; however,
confrontation increases the chance for a violent
reaction. Law enforcement officers should consider
the potential for violence when determining that a
suspect is tweaking. For example, case histories
indicate that tweakers react negatively to the sight
of a police uniform. Confrontation between the
tweaker and law enforcement often results in a
verbal or physical assault on the officer. Besides
confrontation, nobody knows for certain what will
trigger a tweaker to be irrational and violent. A
tweaker exists in his own world, seeing and hearing
things that no one else can perceive. His
hallucinations are so vivid that they seem real.
What law enforcement officers say and do enter into
the abuser's altered reality, and if his paranoia is
triggered, law enforcement appears to be a threat to
the tweaker's life. It is during tweaking that
hostage situations can easily occur. If the abuser
feels cornered, with no means of escape, the tweaker
is likely to take a hostage, often an associate, a
relative, or a police officer. In extreme cases, the
tweaker may physically assault the hostage. If the
tweaker has chosen to ease his discomfort with
alcohol, he becomes a disinhibited tweaker, making
reasoning with him or even identifying him as a
tweaker more difficult. Physical signs of a tweaker
become blurred to an observer when the tweaker is
using alcohol. Motor and speech functions, for
example, become impaired, but not to the degree of a
person using only alcohol. The rapid eye movement
and the quick speech of a tweaker might actually
slow to an apparently normal speed. However, a
tweaker using alcohol can be identified in two ways:
1. First, individuals who can get close enough to
see the tweaker's eyes should look for a
horizontal-gaze nystagmus. This phenomenon occurs
when the methamphetamine abuser, who is also using
alcohol, looks out of the corner of his eyes, and
the eyes jerk back and forth. 2. Second, if
communication lines are open with the tweaker, ask
the tweaker if he is using methamphetamine and then
inquire if he is also drinking alcohol. If a strong
smell of alcohol is present, but no signs of
drunkenness exist, one should err on the side of
caution and approach the person as a tweaker using
alcohol rather than assume the person is harmless.
Because tweakers using alcohol are ordinarily not
concerned with the consequences of their actions, a
situation can quickly lead to violence.

Cities across the United States report increased
percentages of domestic violence incidents
associated with methamphetamine use. Domestic
disputes, ordinarily regarded as dangerous
situations for law enforcement, become intensified
when a tweaker is involved because of that
individual's unpredictability. Many motor vehicle
violations and accidents may also involve tweakers.
Paranoid and hallucinating, tweakers may decide to
travel in their automobiles. Their delusional state
makes moving shapes and shadows appear threatening,
and they are very likely to increase their speed and
exhibit erratic driving patterns as they attempt to
evade the images. An additional threat to society
and themselves may stem from tweaker’s tendency to
arm themselves for their personal safety. Interviews
with methamphetamine abusers have confirmed that
these individuals often maintain weapons in their
automobiles, as well as in their residences.of that
individual's unpredictability. Tweakers may also be
present at raves or parties. In addition, to support
their habit, tweakers often participate in
spur-of-the-moment crimes, such as purse snatching,
strong-arm robberies, assaults with a weapon,
burglaries, and thefts of motor vehicles.
Methamphetamine is readily available and is
spreading rapidly across the United States. Unlike
the abusers in the 1960s and 1970s, today's
methamphetamine abusers cross ethnic and gender
boundaries. Methamphetamine is psychologically
addictive during the binge and high-intensity
patterns of abuse, with users becoming paranoid and
unpredictable.

TREATMENT

At this time the most effective treatments for
methamphetamine addiction are cognitive
behavioral interventions. This approach is
designed to help modify the patient's thinking,
expectancies, and behaviors and to increase skills
in coping with various life stressors. There are
some established protocols that emergency room
physicians use to treat individuals who have had a
methamphetamine overdose. Because hyperthermia and
convulsions are common and often fatal complications
of such overdoses, emergency room treatment focuses
on the immediate physical symptoms. Overdose
patients are cooled off in ice baths, and
anticonvulsant drugs may be administered also.